|
October
2004
Radicchio and
Responsibility
When Bill Clinton went
from former commander-in-chief to chief in-patient, the media
first placed the blame for his heart disease
on his life-long love affair with fast food. After a couple days
and some admonitions from scientists, coverage revisited the old
debate — genes vs. behavior: which is the more important
determinant of health?
Heart disease and longevity
depend on the interplay between what we were born with and what
we have done since then. Because we
can’t choose our parents, we cannot control our genes. But
we can control our behavior.
And while it is true that individual choices and willpower are
relatively inexpensive commodities, even the simplest prevention
methods can run up against the barriers of cost, time and environment.
A recent study in the
American Journal of Preventive Medicine suggested a strong link
between TV-watching and obesity among black
girls age 6 to 9. It wasn’t about laziness; it was about
safety. The children didn’t want to go outdoors, and their
mothers didn’t want them to either, citing traffic, unrestrained
dogs, poor recreational facilities, lack of sidewalks and a general
unwillingness to let the girls play outside without supervision.
Wealthier neighborhoods have more than three times as many supermarkets
as poor neighborhoods, limiting access for many people to the basic
elements of a healthy diet, especially when the quality of produce
and vegetables is so much worse in stores in low-income areas and
people are less likely to have cars to find better bargains.
There is another reason
why poor people are struggle with obesity, and it isn’t a lack of character. Foods that are cheaper
(fats, sugars, carbohydrates) are the most energy-efficient. In
other words, throughout history, people have maximized the caloric
and energy value and minimized the cost of what they put on the
family table. It isn’t going to be radicchio, salmon, raspberries
or merlot.
Good disease prevention, like good medical treatment, is expensive.
In all forms of consumption — whether eating or purchasing
health care — balance is the ideal. We have to balance personal
responsibility with the obligation of social institutions to make
achieving health a choice available to all. It means a larger public
investment in safe neighborhoods. It means public agencies promoting
health information that reaches people at their level of understanding.
It means changing U.S. agricultural and trade policies and getting
the sugar industry out of the regulation-making process. It means
greater reliance on company-sponsored prevention initiatives.
In short, it means helping people who want to change their behavior
to do so with as few barriers as possible.
PDF
version |
